When does GERD testing become cost effective?

GERD affects as many as 40% of Americans. Millions of pts could potentially be treated with PPI therapy expectantly without a definitive diagnosis. This study looked at actual cost in an integrated healthcare system to determine when GERD testing might become cost effective when pts are placed on high dose PPI therapy. The primary care network oversees 120K pts with as many as 50K have electronic medical record (EMR) data and integrated pharmacy data. 2331 were taking PPI’s. 224 were taking at least double dose PPI therapy. Integrated payor data showed the actual cost to the payor side of the system for PPI’s. Payor data was available for the actual cost of esophageal manometry, 48hr Bravo, upper endoscopy (EGD). From these data and historical data indicating incidence of negative workups (no GERD=stop PPI’s) the breakeven point for GERD testing was calculated. Accounting for the time value of the money invested in early GERD testing, a negative evaluation rate of 31% (1), and the average cost of double dose PPI’s actually prescribed in this cohort, we found that pH and manometry testing is cost effective at 18 months of PPI therapy. If EGD is added, then the breakeven points is 30 months. While it is difficult to discern from this relatively young EMR the preponderance of pts were on PPI therapy for much greater than 30 months. Development of cost effective best practices may be inferred from data such as these. Pts who are placed on high dose PPI therapy should receive early GERD evaluation in order to determine an actual diagnosis, extent of disease, and the presence of pre/malignant lesions. Esophageal cancer is rising in the United States thus In addition to being cost effective this paradigm facilitates early cancer detection. (1) Mainie I, et al Gut 2006